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First report of mirtazapine-induced arthralgia
Objective:
The aim of our work is to describe the first two cases of arthralgia associated with the antidepressant drug mirtazapine.
Method:
Descriptive analysis of two iatrogenic cases. The review of the literature was achieved by the traditional electronic methods. The French database of iatrogenic cases was consulted.
Results:
A 53-year-old man presented with gonalgia after some weeks of mirtazapine treatment. The intensity of the arthralgia was correlated with the dosage and the adverse effect rapidly disappeared after the antidepressant therapy was stopped. A 38-year-old woman received mirtazapine for 3 months and complained of arthralgia and myalgia. This clinical picture was suspended as the drug was stopped and a positive reintroduction was observed. No other cause was found in these two patients.
Discussion:
No similar case has been reported in the international literature, but several observations of arthralgia with mianserin are mentioned. As mirtazapine is the 6-aza derivative of the tetracyclic antidepressant mianserin, the similarities of their chemical structures begs the responsibility of mirtazapine for arthralgia.
Insights
Mirtazapine, an antidepressant, may cause joint pain (arthralgia) and muscle pain (myalgia). Symptoms resolved after discontinuing the drug, suggesting a link between mirtazapine and these adverse effects.
Area of Science:
- Pharmacology
- Clinical Medicine
- Neuroscience
Background:
- Mirtazapine is a widely prescribed tetracyclic antidepressant.
- Arthralgia and myalgia are potential side effects of various medications.
- The iatrogenic potential of mirtazapine requires ongoing investigation.
Observation:
- Two distinct cases of arthralgia were observed in patients treated with mirtazapine.
- One patient experienced gonalgia (knee pain) correlated with mirtazapine dosage.
- Another patient reported arthralgia and myalgia, which resolved upon drug cessation and reappeared upon reintroduction.
Findings:
- The observed arthralgia and myalgia were directly linked to mirtazapine use.
- No alternative etiologies were identified for the patients' symptoms.
- Symptom resolution after mirtazapine discontinuation and recurrence upon reintroduction strongly suggest a causal relationship.
Implications:
- These cases highlight a potential, previously unreported adverse effect of mirtazapine.
- The structural similarity between mirtazapine and mianserin (another antidepressant known to cause arthralgia) supports this association.
- Clinicians should consider mirtazapine-induced arthralgia in patients presenting with unexplained joint pain.